Something I had to figure out when I had dialysis at the clinic was scheduling. Everyone wants dialysis to work with their schedule, but sometimes that doesn't happen. One thing I had going for me was that I was one of the few people who actually worked a full time job, which meant that I got to pick the time that best suited me. So I chose the earliest shift possible, which meant arriving at 5:45am. It was always so quiet on the freeway at that time, most people just waking up, but none of the "good" radio shows were on at that time. They all started at 6.
When I walked into the clinic I sat in the waiting room and waited patiently for the nurses to open up the doors for the morning shift. Small conversations took place, but nothing really of importance. Glances were exchanged between people, and if the nurses were late we all would shake our heads as if to say, "What is taking them so long?" We would all hear and watch as medical transport vehicles would pull up and drop off patients. I guess some patients were unable to drive, in a wheel chair, or didn't have someone to drive them. I remember being thankful that I could drive myself and that I had people at home and at work that asked how I was doing, unlike the number of people who only left their nursing home once a day, to go to the dialysis clinic.
When I finally got to go in, I had a routine that I followed every time. I would walk through the door and look at the pictures displayed up on the wall that were supposed to encourage us as patients. The pictures were usually of an event that had been held at the dialysis center, or of a holiday. I understand that the center was trying to help, but I never enjoyed seeing pictures of patients on dialysis while nurses stood behind them dressed up for Halloween. After the pictures I would look at the Kt/v chart. I still don't know what Kt/v stands for, but I know it measures how well you dialyze. They only posted results once a month, but I still looked everytime to see if there were new results. I wanted my Kt/v to be higher, but it never really rose. When you have a low Kt/v, there are a couple different elements the doctor can change to make it better: a different filter and extended time on the machine. I started out at 3 hours on the machine, and once a month the doctor would come in, look at my results, and increase the time on the machine. I remember feeling crushed every time he would raise it by 15 minutes. It felt like a defeat every time. I ended up at 4 hours, which translates into 5 hours by the time I got hooked up and unhooked from the machine.
The other part of my routine was to weigh myself before the treatment. Since one of the functions of dialysis is to remove excess fluid from your blood, everyone tries to find their "dry weight." The dry weight is how much you weigh without any excess fluid in your body. Once you find the dry weight, every dialysis session tries to get you back to the dry weight. Every thing is done in kilograms, and for a guy who grew up learning about pounds, kilos made no sense at first. It was common, especially on a Monday, to be 4 kilos over the dry weight, which meant that over the next four hours, 8.8 pounds would be taken out of my body. Trust me, that is no picnic. You feel pretty horrible after losing that much fluid, and your blood pressure, heart rate and even the size of your blood vessels go through some dramatic changes as a result. I would try to be as light as possible during the weigh-in, taking off my shoes, sweatshirt, and emptying my pockets to get the weight down.
Everyone passes the time differently while they sit on the machine. Most watch TV or sleep. I tried reading and it worked for awhile, but eventually I would end up watching TV too. My favorite channel was the NFL channel, especially during football season. Replays of games and highlights seemed to pass the time quickly. But when it was not football season, I could only take so much of training camp or reports about rumors of trade talks or hold outs.
Each person is supposed to bring headphones to listen to their TVs, but rarely did anyone bring them. Which meant there was a small audio war constantly going on in the center, with each person turning their volume up to avoid hearing other programs. Thankfully there was a small volume controller that was wired to each chair that had a speaker on it to listen to your show. Most people kept the controller near their chair and had their volume turned up all the way. I found that if I put the controller on my shoulder, I could keep the volume at a low level and still hear the TV. However, no one else did the same thing.
There was one gentleman who had the same TV routine everyday. I have no clue what he did for the first 3 hours, but the last hour was reserved for watching "The View," and falling asleep with the volume still very loud. I couldn't stand it, and believe me I am a very patient guy, but that I couldn't take. A happy moment was when I found out that my TV remote actually worked on his TV, and I would slowly turn his volume down while he slept. I tried to never turn it down too much at one time, but rather do it in small increments so he wouldn't notice. Eventually he would wake up and wonder why he couldn't hear his show. He would turn it right back up. All my hard work, reversed. I would have to wait for my next opportunity to start the process all over again. He caught me once or twice turning his volume down. I wondered if he knew I was doing it on purpose, though I shrugged it off as an accidental TV remote misfire.
I remember all the people who came and visited me while I was on dialysis. My brothers both came a couple of times, Eileen the High School Director from the church where I work, and my dad. I specifically asked my wife not to come because I didn't want our son Calvin to be in an environment where infection and sickness seemed to be frequent. My dad was the most frequent visitor, every Friday at 8am. He would stop at Carl's Jr to pick up a coffee and then sit next to me. Visiting a dialysis center can be awkward with all the machines, tubes, blood and noise in the room. My dad was always a welcomed visit. He would just sit with me and talk about what was going on and didn't seem to mind all the chaos around us. He would tell me what poetry he was working on, and we would talk about what was happening at the church. I was always amazed that every time he came he sat on a small stool for 2 hours. It looked to me to be about the most uncomfortable seat in the world, but he did it every Friday. Most visits were easy. I did my time on the machine, and we would go out to breakfast afterwards.
I recall one visit that I know he didn't like, and I didn't like it either. When you remove fluid from the body, it is possible to go too low, or too dry. When this happens, your blood pressure can drop and you can pass out. One Friday I had started cramping, which was the usual signal that I'd had too much fluid removed. The cramping is horrible. It is one thing to get a cramp in your calf, because you can stretch it out, even though it hurts like crazy. But it is a whole other thing when you try to stretch your leg and you cramp on the front side of your leg and the backside. There is no way to stretch your muscle, so you just sit there in intense pain. So there I was on the machine with my legs cramping severely. However, I knew it was trouble when my peripheral vision started to go dark. I don't know what my dad was saying, but I remember interrupting him and telling him to get the nurse. He must not have heard me very well, because he asked me what I said. I could feel my body getting ready to pass out and felt really hot, sweating even. "Get the nurse, QUICK!!" He heard me that time and then maybe noticed that I looked pretty bad. In previous visits I had told him to ignore my cramping and just let me deal with it, but this was different. I know my dad didn't like seeing the nurses come running and start doing things. Really all they do is put your feet up and add some fluid from a saline bag attached to the tubes. Instant relief. It is quite strange to be that close to passing out and then feel better with a little fluid. But to see your son in such a place must feel horrible too. With two little boys of my own, I hope never to have to witness that. Sorry, Dad.
At one of my dialysis sessions, the nurse started talking to me about getting another type of dialysis. The port that I had in my chest would eventually have to come out because the chance of infection was too high. There were two types of dialysis I could choose from. One was called peritoneal dialysis and the other was to continue with hemo-dialysis. Peritoneal dialysis is where they insert a tube into your abdomen, and your peritoneal sack, which holds all your organs together, is filled with a fluid that dialyzes your blood from the inside. Or I could continue with hemo-dialysis. After some research, I decided to go with the hemo-dialysis, mostly because I didn't want a tube permanently sticking out of my belly.
In order to stick with hemo-dialysis, I had to have surgery to create a fistula in my left forearm. This was a weird experience. I had to get an ultrasound of my left arm to measure how wide each vein was. They wrote with a Sharpie all up and down my arm with little numbers to indicate how wide the vein was, in millimeters. The surgery involved redirecting one of two arteries in my arm near my wrist, making it do a "u-turn" into my vein. Usually the arteries run into your hands, and then once the blood is used by your hands it returns through the veins back to your heart. By creating the fistula, I would have only one artery running to my hand. The other would begin to increase the size of the vein so that it would be big enough to insert needles into my arm for dialysis. When I had dialysis now, needles would be inserted into my arm in the same place every time to create a "button hole." The dialysis machine would hook up to these needles instead of the port in my chest. I like to think of the button hole being similar to a pierced ear. By inserting the needle in the same spot and the same way, it creates a tunnel of scar tissue which the needle travels down and goes into the vein. After the button hole is established, a dull needle is used instead of sharp, and it is surprisingly easy to get the needles in.
After my button holes were established, I met a nurse named Kelly who would change my life for the better.
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